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Monday, March 22, 2010

Aligning Health IT and Health Reform

Below is a video and information from a July 15, 2009 event by The Markle Foundation, the Center for American Progress and the Engelberg Center for Health Care Reform. They had been working with a wide array of collaborators to develop criteria for the "meaningful use" of the ARRA's health IT investments to increase their sustainability and foster and support health system transformation.

Achieving an Information-Driven Health Care System

"There's an incredible amount of energy in the private sector that wants to make health care better. But the private sector needs guidance in order to ascertain what exactly we're trying to do, what is policy trying to accomplish, where should innovation head, what are we trying to do as a country," said CAP Senior Fellow Todd Park at the event jointly hosted by the Center for American Progress, the Markle Foundation, and the Engelberg Center for Health Care Reform at the Brookings Institution.
In addition to Park, speakers included David Blumenthal, national coordinator for health IT at the U.S. Department of Health and Human Services, Zoë Baird and Carol Diamond from the Markle Foundation, and Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution.
The speakers were also joined by a number of panelists: Christine Bechtel from the National Partnership for Women & Families; Hunt Blair from Vermont Health Access; Steven Findlay from the Consumers Union; David Lansky from the Pacific Business Group on Health; and Steven Waldren from the American Academy of Family Physicians.
Baird, Diamond, Park, and McClellan argued that committing to specific health targets will guide health IT investment and health care reform toward improving health outcomes, expanding coverage, and reducing cost growth. By digitizing and networking health information, health IT gives physicians access to a patient's comprehensive medical record (including medical history, medications, and test results) and allows them make more informed decisions and to coordinate care with other providers. What's more, health IT can increase safety by alerting physicians about potential drug allergies and interactions and by transmitting their orders with fewer errors. Health IT can also help reduce costs and cut down on administrative hassles.
The American Recovery and Reinvestment Act, or ARRA, authorized over $30 billion in potential incentive payments to health care providers for achieving “meaningful use” of health IT, and directed HHS to craft the standard for “meaningful use.” To ensure that ARRA's health IT investments actually foster innovation in technology and care delivery, speakers argued, the standard should be guided by five criteria:

Set clear and achievable health improvement targets for 2015.

Focus on information use over technology features.

Tie payment to results.

Engage patients.

Craft a smart standards and certification regime that encourages innovation.

Baird, Diamond, Park, and McClellan strongly endorsed the ambitious targets proposed by an HHS advisory committee working with Blumenthal. The goals include: preventing one million heart attacks and strokes; cutting rates of medication errors, preventable hospitalizations, and racial/ethnic disparities in diabetes control in half; and providing patients with easy access to their own health information. CAP, Markle, and Brookings also proposed adding two 2015 goals to specifically address growth in health care costs: identifying duplicative health care services and reducing them by 50 percent, and halving the time spent by physicians on administrative tasks.
Park praised the targets as clear, bold, and achievable. "Why specifically do we love these goals? They're not platitudinous wonkery, they're concrete, everyone knows what they mean," he said, suggesting they can orient both ARRA's health IT investments and the broader health reform effort.
Standards and certifications, such as the standard for “certified electronic health records,” are still evolving. "Certification needs to be as simple and as focused as we can get it. The technology that we want and need for 2015 is not the technology of today. We still need a lot of innovation," said Waldren.
Speakers also argued that the stimulus package's health IT investments must be aligned with broader payment, benefit, and regulatory reforms of the American health care system. According to McClellan, quality measures are a "necessary prerequisite to implementing payment reform, where providers are paid not just for specific services but for actually improving outcomes and lowering costs."
Patients must also be involved in shaping the evolution of "meaningful use" of technology. "Patient experience surveys can tell us a lot, not just about what my experience of care was like in the physician practice or in the hospital, but also about whether I understood the [health] information that was given to me," said Bechtel.
As complex as health IT policy is, McClellan stressed that it is only one piece of the health reform puzzle. "Let's face it. Health IT can help achieve these [2015] goals, but it sure can't do it alone. We will also need better health care organizations, new kinds of staffing and delivery, better decisions by providers and patients," he said.